DRAFT – work in progress

Cambridgeshire and Peterborough

Primary Care Strategic Delivery Plan DRAFT V9 June 2019 DRAFT – work in progress Executive Summary The CCG published its General Practice Forward View Strategy in 2017. This set out the local ambitions for supporting the sustainability and transformation of General Practice. The Primary Care Strategic Delivery Plan is the refresh in light of local system plans and in the context of national contractual changes and policy direction. In January 2019, NHS England published The NHS General Practice Delivered at Scale Long Term Plan (LTP) set out the overarching long- 21 Primary Care Networks have been established term goals for the NHS and specific changes for across Cambridgeshire and Peterborough. Primary Care. To support delivery of the Primary Community, voluntary and local authority services will Care elements, amendments were needed to the now start to wrap around the same geography to national GP Contract and these were published in the form of Investment and evolution: A five-year develop a placed based approach to the health, care framework for GP contract reform to implement The and wellbeing of the local population. NHS Long Term Plan. Cohesive Online and Extended Access Sustainability and Transformation Partnerships Improved access to Primary Care in terms of (STPs) have been asked to include a revised consultation modality. Primary Care Strategy, setting out how they will Workforce and workload optimisation ensure the sustainability and transformation of Primary Care and general practice to improve Effective retention of Primary Care workforce resulting population health covering 2019/20 to 2023/24. in reduced rate of attrition and build of resilience. As an STP that is coterminous with a single CCG, Digital and estate future-proofing Cambridgeshire and Peterborough CCG has Digital solutions to underpin integrated service delivery developed the Primary Care Strategic Delivery Plan and aligned to Primary Care, with ambition of on behalf of the STP and will work in partnership achieving an Integrated Care Record. with the North and South Alliances to support its Improve quality of Primary Care estate that supports implementation. The STP and Alliances vision for frontline service delivery for patients, in the context of Integrated Neighbourhoods will be in Autumn 2019, Integrated Neighbourhoods. by agreement with NHSE/I. 2 DRAFT – work in progress Our population Within Cambridgeshire and Peterborough, NHS partners, Primary Care and local government have come together to improve the quality of health and care of our local population and to return the STP system back to financial sustainability.

Overall, Cambridgeshire and Peterborough is a healthy place to live and one that compares generally well with national health and North population: wellbeing determinants and outcomes. However, there are areas 565,000 within Cambridgeshire and Peterborough with more widespread health and wellbeing issues where health determinants and outcomes are often more adverse than in Cambridgeshire and Peterborough and often similar to, or worse than, national averages, e.g. in Fenland. There are also some very small areas, often with relatively high levels of disadvantage and deprivation, which have correspondingly adverse health and wellbeing determinants and outcomes. In some areas of Cambridge City in particular further attention may be needed to reduce health inequalities and to reverse emerging adverse trends in some health determinants and outcomes. While the economy of Cambridge City is booming, the health of people in Peterborough is varied compared with the England average. Peterborough is one of the 20% most deprived districts/unitary authorities in England and about 23% (10,400) of children live in low South population: income families. Life expectancy for both men and women is lower 415,000 than the England average. Life expectancy is 8.4 years lower for men and 6.1 years lower for women in the most deprived areas of Peterborough than in the least deprived areas. 3 DRAFT – work in progress We expect continued growth but forecasts from different sources vary Cambridgeshire and Peterborough - absolute long term (20 year) population change, 2016 to 2036 (all ages)

Source: ONS 2016-based Subnational population projections and CCCRG mid-2015 based population forecasts (JSNA CDS figure 8)

4 DRAFT – work in progress The CCG’s GP registered population is also growing

Cambridgeshire and Peterborough CCG registered population, 2011-2018* NOTE: axis does not start at 0

*Data from April each year. Data for the period 2011 and 2012 (prior to the start of the CCG) are estimated. Source: Serco and NHS Digital (JSNA CDS figure 5) 5 DRAFT – work in progress Challenges for Primary Care Primary Care in Cambridgeshire and Peterborough has significant challenges to meet the needs of both the patients and the workforce.

Our system faces increasing demand for local illnesses need and want integrated, proactive care services. We are one of the fastest growing to keep them healthy and well at home. They value areas of the country, with an ethnically diverse continuity of care with their Primary Care team. population. The Cambridgeshire and Peterborough registered population is growing by Our current workforce is ageing, and we are 1.95% year on year (Compound Annual Growth struggling to recruit and replace Primary Care staff Rate). Increasingly complex care pathways are not in many areas. We need to enable general practice consistent or readily adaptable, Primary Care to be a more attractive place for people to work and services are currently ill-equipped to manage to create the employment opportunities for new complex elderly and multi-morbid patients. Several roles across the skill mix. practices are being identified as requiring support to improve resilience. We need to Operational and workforce pressures are resulting change the way Primary Care operates, to better in an increasing number of financially manage the demand and complexity coming challenged practices, including some where the through the doors. salaried GPs are earning more than the practice partners. Alongside the unique position the system Our elderly population is growing rapidly, finds itself in regard to the national Carr-Hil funding increasing the number of people with long-term formula and the global sum allocation to practices. conditions, with 51% more over 75s expected by 2026. Previously unaddressed needs such as Demand on services is even higher due to high mental health problems are being recognised, with patient expectations. Patients want a seamless a requirement to meet them. We need to improve service experience across health and care the ways we address issues of prevention in organisations. Services may be co-located in the Primary Care, working with our public health and same buildings, but not integrated with each other. social care colleagues. Patients with long term We need to work better with our partners in 6 community, social, voluntary and secondary care. DRAFT – work in progress Redeveloping our Primary Care strategy Cambridgeshire and Peterborough’s Primary Care Strategic Delivery Plan is being refreshed to meet our challenges and is be shaped around the STP ambition for Integrated Neighbourhoods, the CCG’s priority area of GP Services Delivered at Scale and will build on the ambitions set out in its current GPFV strategy.

The CCG published its General Practice Forward The cornerstone of each Integrated Neighbourhood View Strategy in 2017. This set out the local is a PCN. Cambridgeshire and Peterborough’s ambitions for supporting the sustainability and population of almost one million patients will be transformation of General Practice . It is timely to covered by 21 PCNs. refresh this strategy in light of local system plans, a growing population and in the context of national The CCG’s Operating Plan sets out six “Big Ticket” contractual changes and policy direction. focus areas for 2019-2021. The CCG has identified GP Services Delivered at Scale as one of these The Cambridgeshire and Peterborough STP plan to areas of focus. This will ensure commissioning of improve the health and care of our local population services is aligned to the emerging PCNs to ensure and bring the system back into financial balance better sensitivity to population need and to support was published in October 2016. The STP are the development and purpose of Primary Care at adopting one approach for the improvement of all scale. Ensuring that improving quality and patient public services by focusing on place based experience is at the heart of this. improvement and locally tailored services to meet the local population need. Strategic delivery will be underpinned by the requirements and timeframes set out in the recently There are three areas of focus under this combined published Investment and evolution: A five-year programme of work to help support developments framework for GP contract reform to implement The within the different areas of health, social care and NHS Long Term Plan and Health and Social Care wider public services; Primary Care Networks, regulations. Think Communities and Integrated Neighbourhoods. 7 DRAFT – work in progress Place-based approach

There are three areas of focus of place based improvement to support developments within the different areas of health, social care and wider public services.

Place Based Approach • A collaborative approach to improving the health, wellbeing and quality of life for our population. • Achieved by working together to create a focused and local approach to service design, delivery and improvement based of the needs of the local population. A single view of the place will be created through shared intelligence and understanding of local issues. • The placed based approach will have a common geographical boundary of 30-50k, based on the GP practice the resident is registered to and around the PCN geography. Integrated Primary Care Networks Think Communities Neighbourhoods

• A group of GP practices • Will fundamentally change the • With PCNs as their cornerstone, working together to cover relationship and culture between the Integrated Neighbourhood communities of 30-50k. will work together to cover the the Public Sector and • Will focus on improving primary same community of 30-50k. communities by transforming the care services, making General • Will bring together community, Practice sustainable and way the public sector delivers its services by working in places of social, secondary care, mental primary care collaboration with health, voluntary and wider 30-50k. wider health, care and voluntary services to provide proactive services. • Builds upon the strengths and and integrated care to local • This is a national initiative, more specific issues within each place communities which keeps information is available here. and work with communities to people well and out of hospital. improve lives. 8 DRAFT – work in progress STP Footprint - Alliances

The STP has two geographical Alliances, in the North and South. The North Alliance covers Peterborough, Huntingdonshire and Fenland. The South Alliance covers South and East Cambridgeshire and Cambridge City.

NORTH ALLIANCE As of 1 July, the Cambridgeshire and Peterborough system has twelve PCNs in the North and nine PCNs in the South. Alliances have a role in bringing providers together in the two halves of our CCG. They are charged with developing Integrated Neighbourhoods. The Alliances aim to design care which meets the needs of local people within their communities by working collaboratively, putting the population first, and organisational interests second. They will address the triple aims described in the Five-Year Forward View: by improving the quality of care for patients and service users; outcomes for the local population and value for the taxpayer. NHS community teams and the County, City and District Councils are working together on their Think Communities approach which will align to PCNs to support integration opportunities as Integrated Neighbourhoods. Cambridgeshire and Peterborough CCG will lead the development of the Primary Care Strategic Delivery Plan on Cambridgeshire behalf of the STP and will work in partnership with the North population: 415,000 SOUTH ALLIANCE and South Alliances to support its implementation. 9 DRAFT – work in progress Response to stakeholder engagement Throughout the wider engagement with our member practices and key stakeholders, we revised the Primary Care Strategic Delivery Plan to reflect views obtained.

There has been stakeholder engagement via the To address comments raised we are ensuring that LMC, Healthwatch (who will be completing there are detailed Workforce plans for GPs, Nurses engagement work on the NHS Long Term Plan in and the wider workforce and resource is adequately July 2019), GPFV Delivery and Engagement aligned to support Workforce and Workload Group, and the North and South Alliances with the establishment of the Primary Care Strategic Optimisation ambition. This plan will be Delivery Plan. underpinned by separate strategies for workforce as this is a priority for our system due to the Furthermore the Plan was out to our member national shortages of staff and severe difficulties in practices to obtain views on the initial draft ambitions set out in this plan. recruitment. These plans will also include focus on the morale of Primary Care and optimising working The General Practice Delivered at Scale ambition is conditions. Committed resource is in place to supported, and place-based care focusing on specific population needs is welcomed. There is a support retention, training and recruitment. balance to be determined with being ambitious as a It is important that further support is also provided system and walking before we can run. Integration to Digital and Estates Future Proofing ambition. is key and organisational barriers need to be Dedicated resource is being aligned within the CCG removed. Further lobbying with parliament needs to Primary Care Team to support this. be completed. Delivery plans will be clear showing what this Cohesive Online and Extended Access ambition will be imperative moving forward and will underpin means to GPs, having clear measures and focus system working by having joined up services. on quality.

10 DRAFT – work in progress Ambitions (1/2) Our vision for a sustainable future remains, with practices working together to engage a wide range of staff to deliver proactive, standardised and integrated care. There are four areas to support the ongoing transformation journey. General Practice Delivered at Scale Working alongside community, social care, voluntary To build a better health service for our population by sector, and acute providers to have a focused and local ensuring services are safe, accessible and of the approach to service design, delivery and improvement highest quality. Reducing variation in the safety of care. based of the needs of the local population. Establishing 21 PCNs of 30-50k population cluster level Integrated primary and community services for sharing across the Cambridgeshire and Peterborough STP expertise and resource across PCNs to build resilience area. and sustainability. Maximising DES opportunities, establishing PCNs as Engaged patients and carers who are central to any the cornerstone to deliver proactive and co-ordinated decision making about their health and empowered to care, sensitive to specific population needs, maximising prevent and manage their illness. patient care and quality in local communities. Cohesive Online and Extended Access Resilient General Practice at the heart of Integrated Ongoing delivery of improved access current universal Neighbourhoods, with general practice business coverage continued through GP federations, with configuration aligned for PCNs sustainability, ensuring responsibility to pass to PCNs linked to maturity and services are safe, accessible and of the highest quality. subject to ongoing plans for delivery. Clinical Director leadership arising from effective PCNs and supported by education and resources. Digital solutions for demand and capacity management, and online consultation across PCNs. Commissioning for increasingly at scale provision and using new contract options for more localised service Patients directly book into GP via NHS 111. offer (LES, supplementary services, APMS). Promoting the continuous improvement in the safety and quality of Expanded role for PCNs to run urgent care in the commissioned services. community – local plans linked to outcomes of Urgent and Emergency Care (UEC) Round Table system Underpinned by contracting and quality improvement planning. 11 enablers and regulations. DRAFT – work in progress Ambitions (2/2) Our vision for a sustainable future remains, with practices working together to engage a wide range of staff to deliver proactive, standardised and integrated care. There are four areas to support the ongoing transformation journey. Workforce and workload optimisation Digital and estate future-proofing PCN led retention of Primary Care workforce All patients will have online access to their full record resulting in reduced rate of attrition and build of from April 2020. resilience. An empowered workforce that feels All practices offering and promoting electronic valued and has the balance of specialist and ordering of repeat prescriptions and using electronic generalist skills to meet the population needs. dispensing from April 2019. Attracting wider workforce into STP footprint All practices to have an informative and up to date through successful recruitment strategies to meet online presence by April 2020. Including giving all key trajectories, working alongside Training Hub, patients access online to correspondence . HEE and LWAB. Ensuring structures developed for new roles. Improve quality of Primary Care estate that supports frontline service delivery for patients, considering Extending reach of High Impact Changes across all current and future requirements and in the context of practices to address workload pressures and our ambition to achieve Integrated Neighbourhoods assign skill mix effectively across clinical and non- that support wider communities and meet H&SC Act. clinical work areas. Strategic planning for growth sites, learning from our New to PC Nurses offered the Fundamentals of PN developing new town (Northstowe), informing 33 course within first, alongside the national other strategic growth sites across the system, and preceptorship programme. maximising developer contributions (S106, CIL). Offer guided support to newly qualified nurses and Delivering on aims and benefits of ETTF schemes. new to Primary Care Nurses to support recruitment New schemes supported with capital coming from a and retention. range of sources. Refreshed Primary Care estates Maintaining and growing the workforce ensuring strategy – set at PCN and Alliance level. that the area is an attractive option for employees. 12 DRAFT – work in progress General Practice Delivered at Scale Key deliverables: General Practice Delivered at Scale throughout Cambridgeshire and Peterborough by 21 PCNs from July 2019.

PCNs are an essential building block of Integrated Future practice contract mergers will be considered Care Systems (ICS). To support this a new Network by the CCG in terms of alignment to PCNs. General Contract DES backed by financial entitlements has Practice will remain independent contractors to the been established. NHS, with a high degree of autonomy in deciding Covering a typical population of 30-50k and 100% how services are designed and developed. geographical coverage across the system, PCNs Alliances will lead on the development of Integrated will streamline services for patients in the Neighbourhoods to support PCNs develop local community to ensure fewer handovers and greater integrated services, at a pace which aligns with the knowledge of individuals, the best professional for maturity of the PCN and the appetite of the wider the job is maximised, greater focus on supporting community partners. Think Communities will align prevention and self-care locally. to also support integration opportunities. Alongside Working within a clear clinical governance integration with Local Authorities to ensure framework that ensures the delivery of high quality Safeguarding Adults and Children is at the heart of and safe patient care. PCNs will improve outcomes everything we do. and patient experience through a better use of data, The opportunities that PCNs bring will ensure that increased integration of the views of patients and community and Primary Care services become staff and creative workforce solutions without the integrated from a patient perspective, with usual constraints of boundaries and organisations. organisational boundaries invisible in terms of As the STP moves to becoming an ICS, PCNs will delivery of care. They will also provide flexible have a critical role in ensuring that with other options for GPs and wider Primary Care teams. community staff such as community nurses, From 2020/21 PCNs will assess their local community geriatricians, dementia workers, and population by risk of unwarranted health outcomes podiatrists/chiropodists work in an integrated way and, working with local community services, make with Primary Care. support available to people where it is most 13 needed. DRAFT – work in progress General Practice Delivered at Scale Key Deliverables: development, contracting and quality

2019/20: 2020/21: • Introduction of Local Primary Care • Understand contract requirements to monitor Investment Programme in 2019. performance PCN DES beyond April 2020. • Revised LES offer - Oct 2019. • Assess PCN maturity for improved access shift. • Phased support to accelerate 7 x PCNs to • Delivery of national service specifications. Integrated Neighbourhoods – March 2020. • Scoping incentive risk/share schemes for PCNs to • APMS procurement in 2 areas - Nov 2019. support ‘big ticket’ areas. • CCG Assurance Framework established for • Determine contracting approach for Northstowe. incorporation/innovation requests approval. • Improving self-care and management of LTC. • Support GP to meet KLoE of H&S Care Act • Improving patient experience and meaningful co- (2008) and improve CQC ratings. production through true engagement within our • Enable practices to benchmark and reduce diverse communities and through co-production variation via PCN dashboard - Dec 2020. when services are being developed or changed. • Development of an effective, diverse PCN • Compassionate leadership, living NHS values Patient Participation Group - Dec 2020. (Responsive Proactive Coordinated Primary Care) • Improve involving patients in service developments via PCNs – Dec 2020. 2021/22- 2023/24: • Improve SI reporting, share learning through • PCNs to be an integral part of a mature, integrated facilitated learning events – April 2020. quality assurance and safeguarding process • Ongoing support for practice resilience and across health provision in the system and to be full practice mergers (approved by PCCC in partners in workforce planning. consideration of PCNs). • PCNs to be part of a collegiate safeguarding • Ensure all staff have adequate training, framework for health, that supports meeting supervision and competencies required. statutory responsibility and improves outcomes. 14 DRAFT – work in progress Cohesive online and extended access Key Deliverables

2019/20: Improved Access delivered At Scale 2019/20: Extended Hours (PCN DES) • Federations commissioned to deliver pre- • Assessment of PCNs to assume responsibility to bookable and same day appointments 365 deliver extended hours access to their collective days a year, providing minimum of 30 mins registered population from 1st July 2019. appointment capacity per 1000 population • This will deliver convenient physical and digital per week. appointments "in hours", reduce duplication and • CCG required to evidence delivery 75% improve integration between settings such as 111, utilisation from July 2019. Urgent Treatment Centres and general practice. • Ensure appointments have parity with digital • Minimum 1 practice appointment a day, per 3,000 access to other general practice services, patients will be made available for this includes offering online consultations direct appointment booking by NHS 111. and online bookable appointments. • All practices will ensure that at least 25% • 100% of practices are utilising reports from appointments are available for online booking – the NHS England GP Workload Tool or July 2019. equivalent tools to measure capacity and demand for services and take appropriate 2020/21 - 2021/22- 2023/24: actions to redesign and reduce workload by • Implement agreed system changes, to deliver 30 September 2019. extended access reflecting outcomes from local • Provision for NHS 111 direct booking discussions & national review (planned into improved access services for the whole for summer 2019). population covered – 31 March 2020. • Internet First - Total population delivery of patient access to digital services such as online/video consultation and access to NHS App – April 2021. 15 DRAFT – work in progress Workforce and workload optimisation Key Deliverables

2019/20: 2020/21: • Deliver GPFV Priority spending plan • Develop workforce trajectories for 20/21 and workstreams and GPN 10-point plan. approve support plan required to achieve • Workforce trajectories (GPs excl. Registrars workforce targets. 493, Nurses 332, Direct Pt Care 283, admin • To develop priority spending plan for GPFV 1005 (FTE)) Priority workstreams. • Maximise opportunity to recruit additional • Deliver key priorities with a focus on: workforce (IGPR, apprenticeship, National & Local Retention programmes). • Attraction, recruitment and retention. • Develop opportunities to extend offer of support • Workforce flexibility across organisations. & education for wider workforce. • Focus on system leadership, career • Commission support for practices to address pathways and developing effective team workload and achieve High Impact Changes. working. • Contracting of services from Training Hub to • Development of Apprenticeships in Primary Care recruit additional workforce ensuring structures for Nursing associates. developed for new roles. • Improving self-care and management of long-term • New to PC Nurses offered the Fundamentals of conditions and supporting the upskilling of staff PN course within first, alongside the national working at scale. preceptorship programme. • Offer guided support to newly qualified nurses 2021/22- 2023/24: and new to Primary Care Nurses to support • All staff have access to education, training and recruitment and retention. supervision to meet the required competencies for • Pilot of Physician Associate role in Primary Care in Peterborough. their role and working at scale. • Develop a detail workforce plan. • Develop a Practice Nurse strategy. 16 DRAFT – work in progress Digital future proofing Key Deliverables

2019/20: 2020/21: • Delivery of GP contract mandates • Delivery of GP contract mandates • Delivery of additional national mandate as • Delivery of additional national mandate as develop develop in year in year. • All practices offering and promoting • All patients will have online access to their full electronic ordering of repeat prescriptions record from April 2020 and using electronic dispensing from April • Working with Integrated Urgent Care governance 2019. • New governance structures in response to a • NHS App – July 2019 specific directives. • From October 2019 practices will register a • Implementation of new NHS digital, data and practice email address for CAS alerts. technology standards in line with developing core • Move to Windows 10 – December 2019 standards. • GP IT Futures Framework replacing GPSOC establish agreements for all practices by 2021/22- 2023/24: December 2019 • Integrated Care Record - Local Health Care Record • All practices will be giving all patients access (LHCR). online to correspondence by April 2020. • Lloyd George Notes Digitalisation 2022 (subject to • By April 2020 practice will no longer use fax national contract agreement) machines. • All practices to have an informative and up to date online presence by April 2020

17 DRAFT – work in progress Estate future proofing Key Deliverables

2019/20: 2020/21: • Identify short to medium term development • Ensure both commissioners and providers needs and opportunities of the local Primary understand their responsibilities in helping shape Care property portfolio. and deliver the future estate for transforming • Support General Practice to navigate the Primary Care in line with the Long Term Plan. complex NHSE Premises and Estates • Set the trajectory for medium to long term Business case approval process. development planning and investment to deliver • Successfully deliver on 2019/20 Primary upon the vision and commissioning intentions of Care ETTF pipeline schemes - Mar 2020. the CCG and the wider STP. • Support the development of the wider STP • Review compliancy of existing estate to ensure Premises and Estates Strategy - Jul 2019. they remain fit for purpose into the future. • Understand the impact of growth in PCNs • Develop a strategic system estates framework to and support to develop plans to address this. support delivery of Primary Care, considering • Maximise s.106, CIL and third party Health and Local Authority assets. developer contributions to support premises • Developing a locality plan, to support the developments and growth from infill and development of estate solutions. larger scale strategic developments. • Improve communication and promote 2021/22- 2023/24: engagement across the system when • To agree a set of strategic aims that provides the responding to Planning consultations. longer-term framework for Primary Care estates • Identify under-performing assets to enable development and utilisation, upon which re-use or release, creating improved stakeholders agree, as the basis for delivering efficiency and re-investment opportunity. change. 18 DRAFT – work in progress PCNs helping to deliver ‘out of hospital care’ There will be opportunities for PCNs to shape ‘out-of-hospital’ care, and support the dissolvement of the historic divide between primary and community health services. Round Table Programme • Ambulance (non-cat 1) The CCG are currently leading on the development • Clinical Assessment Service of a Reactive Out of Hospital Urgent Care • Step down (step up) community beds. programme. This will provide a local and simple • Reactive social care services integrated 24/7 urgent care service which delivers Through a constructive collaborations process the effective patient outcomes, that reduces duplication following design principles have been agreed upon and maximizes the workforce. There is a need to: which the solution would be based: • Decrease the inappropriate use of emergency • model will be based on the premise that the departments preferred route through to ED will be via • Provide a timely access to appropriately ambulance or a central triage service principal qualified health & social care professionals • taking into account a variety of infrastructure • Provide patients with a wider “at home” option support services to enable the model to operate • Improve access to urgent appointment through i.e. patient transport. scheduling non-scheduled care • build the model around case examples to test • Improve the availability of information the thinking and development Out of hospital urgent care providers have been • include patient engagement as we now shape working together in proactive conversations to talk the model in full detail through how different ways of working can improve the patient experience and reduce activity With the establishment of PCNs in acute services. The scope includes: in July, this will inform • NHS 111 & Out of Hours GP provision discussions moving forward • GP Extended Access (includes Improved and support coproduction with Access At Scale & Extended Hours) patients. • Urgent Care and MII Centres 19 DRAFT – work in progress Reducing pressure on emergency hospital services Funding opportunities will help support the expansion of PCNs to help reduce pressure on emergency hospital services.

New national Network Investment and Impact Fund NHS England will work with stakeholders including starts in 2020, rising to an expected £300 million in GPC England to evolve and implement a single 2023/24. This is intended to support ICS delivery of coherent access offer that PCNs will make, for both the NHS Long Term Plan. physical and digital services. This will deliver The scheme will be overseen by ICSs. PCNs will convenient appointments ‘in hours’, reduced need to agree with their ICS how they spend any duplication and better integration between settings monies earned from the Fund. such as 111, urgent treatment centres and general Part of the Investment and Impact Fund will be practice. The review will start in 2019, for full dedicated to NHS utilisation, which could cover: implementation by 2021/22 but we expect local • A&E attendances Integrated Care Systems and their PCNs to go • Emergency admissions faster and encourage them to do so. An expanded • Hospital discharge role for PCNs in running urgent care in the • Outpatients community will be made easier by the flexibility for • Prescribing CCGs to add Supplementary Network Services to The Fund will be linked to performance and its the new Network Contract, on a voluntary basis. It design will be agreed with GPC England and could also see networks benefit from payments Government. We envisage that access to the Fund reflecting their impact on A&E attendances, as part becomes a national network entitlement, with of the new Network Investment and Impact Fund. national rules as well as locally agreed elements. Networks will agree with their Integrated Care System how they spend any monies earned from the Fund. 20 DRAFT – work in progress PCNs can have significant impact on personalised care There are opportunities outlined in the Network Contract DES for PCNs to have significant impact on personalised care.

The Network Contract DES introduces seven range of support available to people will widen, specific national service specifications, where PCNs diversity and become accessible across the can have a significant impact. One of which being country. PCNs will be able to recruit a Social Personalised Care. Prescriber Link worker, with full financial entitlements for five years from July 2019. The Comprehensive Model of Personalised Care has six main evidence based components: There is scope to focus on changing the conversation with the public and patients to an 1. Shared decision-making ‘asset based’ approach. Mobilising the skills and 2. Enabling choice, including legal rights to choice knowledge of individuals and the connections and 3. Personalised care and support planning resources within communities and organisations rather than focusing on problems and deficits aims 4. Social ‘prescribing’ and community-based to empower individuals, enabling them to rely less support on public services. 5. Supported self-management The CCG currently supports self management of 6. Personal health budgets and integrated hypertension with resources available for staff and personal budgets. patients. Also, the Self Care Prescribing policy which is supported with patient resource leaflets The elements have been proven to improve health and self care fact sheets available online. and wellbeing outcomes, increase patient satisfaction as well as reducing the direct costs of Also, there is the national scheme ‘Healthier You care (for example of continuing healthcare Diabetes Prevention’ programme, set up by NHS packages, and through social prescribing reducing England. It is a behaviour change programme GP attendances and wider NHS use). aimed at patients who have been identified as at risk of developing diabetes (patients with non- As part of this work, through social prescribing the diabetic hyperglycaemia). 21 DRAFT – work in progress Population Health will support PCNs

Local NHS organisations will increasingly focus on population health – moving to Integrated Care Systems everywhere Analytics Community CCG and STP Joint Business Intelligence To aid delivery of Population Health Management a PCN formation has been supported by providing STP Analytics Community was established, information about practice populations and their meeting monthly and includes membership of usage of services. technical experts from across the whole of the Subsequently a trail of a risk segmentation model health economy and social care. The group also based on the National Association of Primary Care includes representatives from Public Health model is underway and currently running in three England. practices across Cambridgeshire and The group has carried out a review of our system Peterborough. maturity around population health looking at the Reviewing PHM solutions with demonstrations three key capabilities identified in the PHM being arranged for Eclipse Live and RaidR in the Flatpack. This identified opportunities for coming weeks to evaluate the art of the possible improvement across all those capabilities. and how that aligns with what we want to deliver. A PHM workshop is being developed to ensure there is clarity on what we want PHM to deliver, Integrated Care System (ICS) how we are going to get there and be clear with our All STPs will become ICSs by 2021. The STP stakeholders why we need to do this. Board are leading on further work on longer term Close working between Local Authority partners models for greater system integration including whose Think Communities work aligns with our own arrangements for governance, leadership, work on PCNs is in place. This aims to bring commissioning and provision. Local federations, together the knowledge we have of our system to the LMC and chairs of the North and South Alliance better design and improve quality of services are represented on the STP Board. across Health and Care. 22 DRAFT – work in progress Funding/Investment

Investment in PCNs is important to ensure sustainability of Primary Care.

National Investment CCG Investment into PCNs NHSE has confirmed national investment to CCG investment into PCNs support to the Cambridgeshire and Peterborough • £1.50 per registered patient system via a Memorandum of Understanding. For 2019/20 there will be £755,248 allocation and in Clinical Director contribution (population based 2020/21 £821,910 ring-fenced. This funding will be payments) used to support: • £0.514 per registered patient • Practice Resilience Staff reimbursements • GP Retention Programme • Reception and clerical staff training • Clinical pharmacists 70% of salary • Online Consultation • Social prescribing link workers 100% of salary • Practice Nursing (2020/21) Extended hours access Separate ongoing allocations for: • £1.099 per registered patient • Improved access at £6/head • Completion of Estates and Technology CCG Investment into Primary Care Transformation Fund (ETTF) schemes Current LES and QEF programme being These workstreams underpin a number of the key redeveloped to ensure PMS rebasing money is headlines of the emerging revised Primary Care reinvested in Primary Care. Strategic Delivery Plan. Primary Care networks to be offered a new ‘shared savings’ scheme so that they can benefit from actions to reduce avoidable A&E attendances, admissions and delayed discharge, streamlining patient pathways 23 DRAFT – work in progress Resource To deliver the Primary Care Strategic Delivery Plan and the four ambitions resource is key to this, alongside additional capacity within PCNs.

To support delivery of the Primary Care Strategy New roles for Primary Care Delivery Plan the CCG has recently revised its The new GP Contract will deliver the biggest boost Primary Care Team structure to be aligned to to primary care since 2004. Through a PCNs and to support the ambitions. new Additional Roles Reimbursement Scheme, Furthermore the CCG have allocated six PCNs will be guaranteed funding for an up to members of its staff to work directly with PCNs to estimated 20,000+ additional staff by 2023/24: help develop them from 1 July. Who will work • Clinical pharmacists (from 2019/20) alongside Alliance and Integrated Neighbourhood resources. PCNs will have • Social prescribing link workers (from 2019/20) named individuals allocated to the North and • Physiotherapists (from 2020/21) South of the system to support the Clinical Directors. • Physician associates (from 2020/21) Staff from the Trusts and the STP will help PCNs • First contact community paramedics (from develop Integrated Neighbourhoods in their 2021/22). areas. A number of areas have already indicated The Additional Roles Reimbursement scheme will they wish to take this forward. meet a recurrent 70% of the costs of additional The LMC is working with all our practices to help clinical pharmacists, physician associates, support PCNs. Alongside this STP partners are physiotherapists, and first contact community aligning staff to work with the Alliances and their paramedics; and 100% of the costs of additional Integrated Neighbourhoods. social prescribing link workers. Each PCN will be able to employ a pharmacist and social prescriber after 1 July 2019. The CCG will support the Clinicals Directors’ plans to do this. 24 DRAFT – work in progress

Training and education To support the development of PCNs, training of staff is essential for progressive Primary Care teams

The CCG is co-developing a Primary Care Innovation Academy to support our emerging PCN Clinical Directors with the Judge Business School. The programme will start in September 2019.

We will commission the provision of training and workforce initiatives via the Training Hub. This will allow the Training Hub to expand and provide opportunities for Primary Care Network teams.

25 DRAFT – work in progress Governance For the Primary Care Strategy to be delivered, there needs to be a robust governance structure in place to demonstrate transparency across the system and accountability.

The CCGs Primary Care Commissioning To support this there will be a relaunch of the GPFV Committee (PCCC) Oversees commissioning of Delivery and Engagement Group as a stakeholder Primary Care services and ensures the CCG group. delivers its Delegation Agreement with NHSE. The Primary Care Commissioning Committee Alongside setting out the strategy for Primary Care (PCCC) will amend TOR to include responsibilities and Local Enhanced Services. Which reports to the associated with a Primary Care Programme Board, CCG Governing Body. as described in the MOU. It was announced in March 2019 that funding for Primary Care discussions also feed into a number four GPFV programmes will be allocated centrally, of Delivery Groups across the system: by NHSE as a committed investment for two years (2019/20 and 20/21). Money will be received in • Primary Care Operational Group (PCOG) June 2019 and 2020 for each whole year, to each • Workforce and Workload Steering Group STP, rather than to individual CCGs, as one pot of • Primary Care Premises Group / STP Estates money and not by programme. Group It has been agreed with the STP Board that the • STP Digital Enabling Group Primary Care Commissioning Committee will • STP Workforce Groups provide the required governance processes and • NHSE/I Regional Groups ensure delivery plans are fit for purpose, as required by the MOU, including approval of the The STP’s North and South Alliances and the STP priority spending plan for 2019/20 and will provide Health Care Executive will receive reports as update reports to NHSE, confirming outcomes and required. achievements of the STP allocation. 26 DRAFT – work in progress Primary Care Governance Structure Key: CCG STP NHSE/I Stakeholder Group

GPFV Delivery and STP Board Engagement Group Governing Body

Health and Care Primary Care Commissioning NHSE/I Regional Groups Executive Committee (PCCC) GPFV Oversight Group North and South Primary Care Operational Group Alliance (PCOG) NHSE GPFV Workforce Sub Group Digital Enabling Group

Primary Care Workforce Premises and Estates and Workload Steering Steering Group Group - New Training Hub Steering Group STP Estates Group

Local Workforce Action Board Sub-groups Leadership and Workforce Strategy & Workforce Supply and Education Organisation Delivery Group Implementation Group Group Development 27